Provider Demographics
NPI:1821060096
Name:MCMILLAN, JEFFREY B (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:B
Last Name:MCMILLAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9360 W FLAMINGO RD
Mailing Address - Street 2:#110-308
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-6426
Mailing Address - Country:US
Mailing Address - Phone:702-505-1900
Mailing Address - Fax:
Practice Address - Street 1:9360 W FLAMINGO RD
Practice Address - Street 2:#110-308
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-6426
Practice Address - Country:US
Practice Address - Phone:702-505-1900
Practice Address - Fax:702-736-1116
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADNO132301223G0001X
NV5215122300000X
NVS3-2271223X0400X
CA555801223X0400X
AZD69461223X0400X
MSOR-509-161223X0400X
NMDD36301223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist